There is sufficient evidence showing that obese individuals are at increased risk for psychosocial comorbidities. Recent studies concur with the earlier review  in finding that obese individuals reported lower levels of self-esteem and weight and body image. Recent studies also suggest a positive relationship between obesity and depressive symptoms, although these findings are somewhat different from those found in the earlier review . Of particular interest is how certain groups of obese individuals are at increased risk for psychologic dysfunction. For instance, individuals with lower socioeconomic status or family histories of psychiatric disorders had higher levels of psychologic dysfunction. Younger individuals, particularly younger women, were at increased risk for poor self-esteem and depressive symptoms. Future studies need to verify that these individuals are at increased risk for psychologic disorders by consistently using valid and reliable measures of psychologic factors. Studies also need to determine why these individuals are at increased risk for psychologic consequences and how obesity exacerbates the problem. In addition to possible demographic risk factors, obese individuals are subject to and engage in behaviors that increase their risk for psychologic comorbidities. One example is that obese individuals who experience weight stigmatization report low levels of self-esteem. It is unknown whether stigmatized individuals experience psychologic consequences or whether obese individuals with affective disorders perceive more prejudice. Future studies of weight stigmatization will be challenging, because the validity of the weight-stigmatization concept is uncertain. Regardless, incidences of weight stigmatization should serve as a proxy measure for psychologic distress and should not be disregarded. Obese binge eaters are another group at increased risk for psychologic disorders. Obese binge eaters have lower affect than obese non-binge eaters, and decreases in their own moods precipitate binge-eating episodes. Understanding the cause of binge eating and its role in the development and treatment of obesity will be an ongoing challenge. Although earlier studies suggested that dieting increased the risk of psychologic comorbidities, this article suggests that the psychologic outcome depends on the weight-control behavior one uses and when psychologic factors are measured during the dieting period . That is, whereas extreme dieting behaviors such as fasting, vomiting, purging, and diuretic and laxative use may lead to deleterious psychologic consequences, moderate caloric restriction and increased exercise may improve psychologic functioning. Similarly, weight-loss regain and weight cycling are related to binge eating and perhaps the psychologic effects related to binge eating. Individuals who experience weight loss and weight-loss maintenance experience increased moods and seem to be similar to individuals in the general population. This article clearly shows that health care professionals need to be sensitive to possible psychologic comorbidities among obese individuals. Physicians should assess whether obese individuals experience depression or depressive symptoms and recommend appropriate treatment. Assessing and treating obese individuals who report psychologic distress due to poor body image or self-esteem also are recommended. Instead of simply inquiring whether an obese patient is dieting to lose weight, it is important to assess the specific weight-control behaviors in which the patient engages. Extreme weight-control behaviors, particularly among adolescents, can lead to deleterious physiologic and psychologic consequences and should be monitored closely. Conversely, moderate caloric restriction and increased exercise may improve moods, either directly or through moderate weight loss. Specific attention needs to be given to socioeconomic status, race and ethnicity, gender, age, and age of obesity onset because these factors are associated with the choice of weight-control behaviors, internalization of the obesity stigma, and body dissatisfaction levels. Identification and appropriate treatment of psychologic comorbidities will help to increase obese individuals' quality of life.
Bibliographical noteFunding Information:
Preparation of this article was supported by grant DK-50456 from the National Institute of Diabetes and Digestive and Kidney Diseases.
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